TY - JOUR
T1 - Mohs Micrographic Surgery Volume and Payment Patterns among Dermatologists in the Medicare Population, 2013
AU - Johnstone, Cameron
AU - Joiner, Keith A.
AU - Pierce, John
AU - Krouse, Robert S.
N1 - Funding Information:
We found considerable practice differences between dermatologists who performed Mohs surgery and those who did not. MMS performing dermatologists performed an average of 5419 procedures funded by Medicare per provider in 2013 and received an average total reimbursement of $475,884. In comparison, non-MMS dermatologists performed an average of 3627 procedures per provider and received average reimbursement total amount of $144,565. MMS dermatologists made up 71.3% of the top decile of dermatologists ranked by total reimbursement received from Medicare Part B in 2013 ($495,348 to $6,422,323) and 42.7% of the next highest decile of dermatologists ($310,930 to $495,029).
Funding Information:
Our study has a number of limitations. First, MMS service and utilization data are limited to the Medicare Part B population. Our results exclude all procedures funded by private insurance. Furthermore, reimbursement totals for MMS procedures completed at a facility location include only the physician’s professional service fee with the institutional facility fee excluded. This data set also excludes records for services performed on 10 or fewer beneficiaries for privacy reasons and in some cases multiple providers may have billed under the same unique provider billing code, skewing totals. Limitations also exist in Medicare billing itself. Clinical data are not provided and information on topics such as surgery location are grouped into broader than desirable categories making it difficult to draw conclusions about provider behavior. Finally, our analysis of total service volume, reimbursement and lesion location grouped into broad categories does not offer enough information to know the reasoning behind treatment selection decisions made by individual providers, particularly why Mohs surgery was used in some cases on the trunk or extremities versus surgical excision or other options. Possible contributing factors include lesion risk level, the potential to save cosmetic valuable tissue with Mohs surgery, and in some cases, possibly economic factors. These data limitations hinder our ability to analyze appropriateness of decision making. This topic would be best addressed with prospective data that include richer clinical information on lesion pathology, surgical planning, and outcomes.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Objectives: Mohs micrographic surgery (MMS) has expanded markedly in recent years but there is limited information on volume, practice patterns or reimbursement. This study characterizes MMS utilization in the Medicare population. Materials and Methods: We analyzed the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File Calendar Year 2013 data set for provider service volume and reimbursement for dermatologists who did and did not perform MMS procedures. Results: Total Medicare-funded MMS procedures increased 25% from 2009 (558,447) to 2013 (700,262). Dermatologists who performed MMS had significantly more average services per provider (5419.4 vs. 3627.1, r=0.16, P<0.0001), were reimbursed significantly more in average total procedure-related compensation (475,883.64 vs. 144,564.74, r=0.49, P<0.0001) than dermatologists who did not perform MMS, and made up 71.3% of the top decile of dermatologists ranked by total reimbursement received from Medicare. Total MMS service volume and reimbursement was concentrated among a subset of providers. Among MMS providers, a higher volume of MMS procedures was correlated with a greater likelihood of performing procedures on lesions located on the trunk, arms or legs (r=0.27, P<0.001). Conclusions: In 2013 reimbursement for MMS comprised almost 19% of the amount reimbursed by Medicare Part B Fee For Service to dermatologists and greater than half a percent of the total amount reimbursed to all physicians participating in the program. Further studies incorporating clinical and outcomes data are needed to evaluate appropriate utilization of this procedur.
AB - Objectives: Mohs micrographic surgery (MMS) has expanded markedly in recent years but there is limited information on volume, practice patterns or reimbursement. This study characterizes MMS utilization in the Medicare population. Materials and Methods: We analyzed the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File Calendar Year 2013 data set for provider service volume and reimbursement for dermatologists who did and did not perform MMS procedures. Results: Total Medicare-funded MMS procedures increased 25% from 2009 (558,447) to 2013 (700,262). Dermatologists who performed MMS had significantly more average services per provider (5419.4 vs. 3627.1, r=0.16, P<0.0001), were reimbursed significantly more in average total procedure-related compensation (475,883.64 vs. 144,564.74, r=0.49, P<0.0001) than dermatologists who did not perform MMS, and made up 71.3% of the top decile of dermatologists ranked by total reimbursement received from Medicare. Total MMS service volume and reimbursement was concentrated among a subset of providers. Among MMS providers, a higher volume of MMS procedures was correlated with a greater likelihood of performing procedures on lesions located on the trunk, arms or legs (r=0.27, P<0.001). Conclusions: In 2013 reimbursement for MMS comprised almost 19% of the amount reimbursed by Medicare Part B Fee For Service to dermatologists and greater than half a percent of the total amount reimbursed to all physicians participating in the program. Further studies incorporating clinical and outcomes data are needed to evaluate appropriate utilization of this procedur.
KW - Medicare payment
KW - Mohs surgery
KW - dermatology
KW - skin cancer
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U2 - 10.1097/COC.0000000000000448
DO - 10.1097/COC.0000000000000448
M3 - Article
C2 - 29672366
AN - SCOPUS:85056803464
VL - 41
SP - 1199
EP - 1203
JO - American Journal of Clinical Oncology
JF - American Journal of Clinical Oncology
SN - 0277-3732
IS - 12
ER -